Since 1995, Reliable Business Intelligence for Clinical Laboratories, Pathology Groups and Laboratory Diagnostics

Volume XXX, No. 9 - June 19, 2023

Optum and Avalon Discuss Genetic Test Claims Review

CEO SUMMARY: With the ever-increasing number of genetic tests on the market, payers are understandably frustrated with genetic test claims that don’t clearly outline the medical need for a procedure or its clinical validity. One path forward is for labs to present data to justify a genetic test earlier in processing of the claim. GENETIC …

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Experts Discuss Genetic Test Claim Review

GENETIC TESTING LABORATORIES CAN EXPECT PRIVATE HEALTH INSURERS to require better data about the accuracy and clinical relevance of the genetic test claims being submitted for reimbursement. That was a common message—and prediction—during several presentations at April’s Executive War College in New Orleans. That prediction did not take long to come true. On May 2, …

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Expect More Z-code Requirements for Genetic Tests

GENETIC TESTING COMPANIES ARE STILL REACTING TO LAST MONTH’S NEWS that one of the nation’s largest health insurers—UnitedHealthcare (UHC)—will require Z-codes for molecular test claims submitted as of August 1. UHC’s action creates an interesting differentiation among genetic testing laboratories. On one side are established labs that already have Z-codes for their genetic tests so …

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Atrium Health’s Advice on Epic Beaker Rollouts

CEO SUMMARY: Starting in 2019, Atrium Health began a years-long process to implement Epic Beaker as its laboratory information system. It was an enormous effort, involving dozens of locations across three states. The lab team’s lessons learned can be applied to other technology rollouts, regardless of the size of the clinical lab. MOVING FROM AN …

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Digital Pathology Business Plan for Both Clinical and ROI Success

CEO SUMMARY: More pathology groups are ready to consider adopting whole-slide imaging and digital pathology. The decision to proceed should only be made after identifying the clinical benefits of these technologies, accompanied by an implementation plan that will deliver an acceptable return on investment. TECHNOLOGY INNOVATIONS AND GROWING DEMAND FOR ACCESS to subspecialist anatomic pathologists …

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CMS: TJC Made ‘Business Decision’ to Not Recognize COLA

Following up on a prior briefing, The Dark Report has learned that the Centers for Medicare and Medicaid Services (CMS) does not appear to have an issue with a decision by The Joint Commission (TJC) to no longer recognize COLA laboratory accreditation in TJC-surveyed facilities. TJC’s announcement was effective Jan. 1, and The Dark Report …

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Proposed Electronic Signature Rule Has Compliance Risks

CEO SUMMARY: Proposed HHS rule aims to define and standardize physician electronic signatures. For clinical laboratories, this is important because lab test claims require a signed requisition form. Given labs’ longstanding challenges in consistently obtaining signatures from certain ordering physicians, implementation of the new rule might be helpful in such cases. Part Two of Two …

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June 19, 2023, Intelligence: Late-Breaking Lab News

Lighthouse Lab Services in Charlotte, North Carolina, recently released survey results in which 52% of respondents indicated they were overworked relative to their positions; 33% described their workload as adequate; and 15% said they were satisfied with their current workload. MORE ON: Overworked Laboratory Staff Although not in the survey results, it’s likely continuing lab …

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